The Impact of Public Housing Closures on Atlanta Mothers' Residential Trajectories and Health Behaviors during Pregnancy Open Access

Abstract

Introduction: Housing is an important determinant of health. Because traditional public housing projects contributed to residential segregation and poverty concentration within neighborhoods, recent U.S. housing policies have encouraged project demolition and shifted residents primarily to portable housing vouchers. There are mixed findings on the health impacts these policy-induced moves had on former project residents.

Methods: We constructed a retrospective cohort of 2,564 women residing in Atlanta, Georgia public housing from 1994 to 2007 who had a birth in traditional public housing, and follow-up birth while residing in either a project or the private market using deterministically-linked birth records of siblings with the same mother. Generalized estimating equations were used to assess the impact of project closure on women's moves to new neighborhoods and important health behaviors including their likelihood to smoke or utilize prenatal care in their second pregnancies. Mediation analyses were conducted to determine whether health behaviors in follow-up pregnancies operated through the magnitude of inter-pregnancy change in neighborhood poverty and deprivation. All analyses were repeated in a propensity score (PS)-matched cohort of 560 women.

Results: Conditional on demographic and other factors, women who experienced project closure moved to neighborhoods with higher percentages of residents in poverty and greater material deprivation. Policy-induced moves were also associated with slight, non-significant protective effects against smoking (adjusted odds ratio (aOR): 0.90, 95% confidence interval (CI): 0.62, 1.31), receiving inadequate prenatal care (aOR: 0.95, 95% CI: 0.76, 1.18), and receiving less than adequate prenatal care (aOR: 0.86, 95% CI: 0.71, 1.04). Health behaviors were not mediated by neighborhood changes. The PS-matched cohort achieved covariate balance, with analyses yielding similar effect estimates.

Discussion: Demolition of housing projects was associated with women's moves to neighborhoods having greater poverty and more deprivation. Policy-induced moves were unassociated with or modestly protective against harmful health behaviors in subsequent pregnancy, but did not operate through changes in neighborhood circumstances. More research on the impact of housing policy changes on health behaviors during pregnancy is warranted.

Table of Contents

Background... 2

Methods... 10

Results... 15

Discussion... 21

Public Health Importance... 26

References... 28

Figures and Tables... 34

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	prenatal care neighborhood effects pregnancy public housing residential mobility smoking
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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